If you would like to book Michael H. Cottman as a speaker at your next event,
show or conference please fill out this form and Michael will get back to you.
Primary Contact Name: * First Last  
       
Primary Contact Email: *    
Primary Contact Phone: *    
Primary Contact Mobile: *    
Secondary Contact Email:    
       
Organization Name: *    
Organization Website:    
Organization Type: *    
Organization Sub Type: *    
Other:    
Additional Organization Details:  
       
Event Name: *    
Role Played in Event: *    
Date of Event: *    
Alternate Date:    
Keynote Topic: *    
Event Start Time: *  :     Hour : Minute AM/PM  
Speaker Start Time:  :        
Speaker End Time:  :        
       
Event Description: *
(include information on: Attire, format, luncheon, dinner, reception
theater seating, etc.) PLEASE DO NOT INSERT A PRESS RELEASE.
 
Panel Topic:
 
Panelists: Specific names and affiliations
(include all invited and their confimation status)
 
       
Venue Name: *    
Address: * Street Address *  
  Address #2  
City: * Zip/Postal Code *  
State/Provence/Region: * Country  
Closest Airport to Venue: *    
       
Audience:
(Please provide a description -- size, students, faculty, ceo, etc.)
 
What media outlets will be present at this event:
 
How is this event being promoted:
 
       
Organization will cover expenses: *



   
Expenses covered by organization:

   
       
Speaker may have products (books, etc.) available for the event. Would you be willing to provide personnel to help with these products?



   
       
Is there an Honorarium?



   
Honorarium Amount:    
       
Deadline for Response: *    






 

If this event is confirmed, we require a 50% deposit immediately upon acceptance to the secure the date
on our calendar. The remaining 50% is due 10 business days prior to the date of the event.